All patients are reviewed using data compiled over that period on symptoms, quality of life, cognition (assessment and reassessments); detailed feedback from case managers and psychiatrists. The majority of patients are in remission at this stage and doing well on several dimensions of outcome. They are transferred to "medical management", continue to be assessed and treated by their respective psychiatrists and are discharged from the case management part of the Program. A small proportion (approximately 15%) following the two year review are deemed to be in further need of intensive and comprehensive treatment in the case management program. They are continued in the full program with the same case manager as during the first two years. In addition, these patients are offered a combined social skills training and stress management program along with clozapine therapy if they have not already received it (provided they have failed to respond to other antipsychotics).
PATIENTS CONSIDERED "AT RISK FOR PSYCHOSIS"
Patients who, following initial screening and full assessment, do not meet criteria for diagnosis of a psychotic disorder but who do meet criteria for "at risk for psychosis" (see below) should be treated as follows:
- Discuss patient with Program Director or Research Coordinator prior to any further disposition
- Do not admit to PEPP
- Complete assessment protocol as for regular admissions
- Create a separate file (blue file) and pass onto research assistant for entry into the data base
- Follow up with a psychiatrist and another clinician as per the following protocol:
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- assess monthly for three months
- every three months for one year unless psychosis develops. If psychosis develops, patient should be re-assessed for admission to PEPP - Tier IV or V
- at each assessment point complete all rating scales
CRITERIA FOR CONSIDERING INDIVIDUALS “AT RISK FOR DEVELOPMENT OF A SCHIZOPHRENIC PSYCHOSIS”
- Family history of schizophrenia or related psychosis in first degree relative and reduction in GAF of 30 or greater, lasting one month
- Attenuated (sub-threshold) symptoms on BPRS on any of the following categories: unusual thought content, suspiciousness, hallucinations, conceptual disorganization
- Same as above, but at threshold lasting less than one week The above criteria are adapted from the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia.
For Assessment Protocol Details (Figure 1) - please see next page.
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